DEBARMENT, SUSPENSION, INELIGIBILITY, AND VOLUNTARY EXCLUSION
LOWER TIER COVERED TRANSACTIONS
State of California HOME Investment Partnerships Program
This certification is required by the regulations implementing Executive Order 12549, Debarment and
Suspension, 29 CFR Part 98, Section 98.510, Participants’ Responsibilities. The regulations were published
as Part VII of the May 26, 1988 Federal Register (pages 19160 – 19211).
(BEFORE COMPLETING CERTIFICATION, READ THE INSTRUCTIONS)
(1) The prospective recipient of Federal assistance funds certifies, by submission of this proposal, that
neither it nor its principals are presently debarred, suspended, proposed for debarment, declared
ineligible, or voluntarily excluded from participation in this transaction by any Federal department or
(2) Where the prospective recipient of Federal assistance funds is unable to certify to any of the
statements in this certification, such prospective participant shall attach an explanation to this
Name of Organization/Business (prospective recipient of Federal assistance funds) – print
Name of Authorized Representative - print Title of Authorized Representative - print
Signature Date (MM/DD/YY)
INSTRUCTIONS FOR CERTIFICATION REGARDING DEBARMENT
By signing and submitting this proposal, the prospective recipient of Federal assistance funds is providing the certification as set out
1. The certification in this clause is a material representation of fact upon which reliance was placed when this transaction was
entered into. If it is later determined that the prospective recipient of Federal assistance funds knowingly rendered an erroneous
certification, in addition to other remedies available to the Federal government, the Department of Labor (DOL) may pursue
available remedies, including suspension and/or debarment.
2. The prospective recipient of Federal assistance funds shall provide immediate written notice to the person to which this proposal
is submitted if at any time the prospective recipient of Federal assistance funds learns that its certification was erroneous when
submitted or has become erroneous by reason of changed circumstances.
3. The terms “covered transaction” “debarred”, “suspended,” “ineligible,” “lower tier covered transaction,” “participant,” “person,”
“primary covered transaction,” ”principal,” “proposal,” and “voluntarily excluded,” as used in this clause, have the meanings set
out in the definitions and coverage sections of rules implementing Executive Order 12549. You may contact the person to which
this proposal is submitted for assistance in obtaining a copy of those regulations.
4. The prospective recipient of Federal assistance funds agrees by submitting this proposal that, should the proposed covered
transaction be entered into, it shall not knowingly enter into any lower tier covered transaction with a person who is debarred,
suspended, declared ineligible, or voluntarily excluded from participation in this covered transaction, unless authorized by the
5. The prospective recipient of Federal assistance funds further agrees by submitting this proposal that it will include the clause
titled “Certification Regarding Debarment, Suspension, Ineligibility and Voluntary Exclusion – Lower Tier Covered Transactions,”
without modification, in all lower tier covered transactions and in all solicitations for lower tier covered transactions.
6. A participant in a covered transaction may rely upon a certification of a prospective participant in a lower tier covered transaction
that is not debarred, suspended, ineligible, or voluntarily excluded from the covered transaction, unless it knows that the
certification is erroneous. A participant may decide the method and frequency by which it determines the eligibility of its
principals. Each participant may, but it is not required to, check the List of Parties Excluded from Procurement or Non-
7. Nothing contained in the foregoing shall be construed to require establishment of a system of records in order to render in good
faith the certification required by this clause. The knowledge and information of a participant is not required to exceed that which
is normally possessed by a prudent person in the ordinary course of business dealings.
8. Except for transactions authorized under paragraph 5 of these instructions, if a participant in a covered transactions knowingly
enters into a lower tier covered transaction with a person who is suspended, debarred, ineligible, or voluntarily excluded from
participation in this transaction, in addition to other remedies available to the Federal government, the DOL may pursue available
remedies, including suspension and/or debarment.
State of California: Department of Housing and Community Development (Rev. 01/09)